Download Congenital Anomaly ICD-10-CM/PCS Coding and DRG Implications

Congenital Anomaly ICD-10-CM/PCS
Coding and DRG Implications
Elsevier Clinical Solutions
Presented By:
Deborah Gardner- Brown,
RHIT,CCS,CDIP,CCDS,C-CDI,CICDI,CCMSCP,CPMA
July 21, 2016
Objectives
Recall the logic for assigning congenital
anomaly diagnoses to surgical/procedural
DRGs
Evaluate the difference between MS-DRGs
and APR-DRGs for surgical/procedures for
congenital anomaly diagnoses
Identify the major procedures that link to
surgical/procedural DRGs for congenital
anomaly diagnoses
Differentiate the Condition
Congenital Anomaly/Malformation/Disorder
• Congenital anomaly/malformation: A physical defect present in a
baby at birth that can involve many different parts of the body.
Congenital malformation can be genetic, it can result from exposure
of the fetus to a malforming agent (such as alcohol), or it can be of
unknown origin. Examples include heart defects, cleft lip and palate,
spina bifida, limb defects, and Downs syndrome. Codes Q00-Q89
• Congenital disorder: Also known as congenital disease, birth
defect or anomaly, is a condition existing at or before birth
regardless of cause. Birth defects vary widely in cause and
symptoms. Any substance that causes birth defects is known as a
teratogen. Some disorders are detected before birth through
prenatal diagnosis. Codes P052- P962
Gather all the Facts
Examine the history - Diagnoses, disorders, syndromes,
and specific anomaly.
• Is the condition actively present?
• Does it require surgical correction?
• Is it a past (corrected) personal history?
• Identify active problems/conditions and
determine the body system/organ affected.
• Identify laterality and or organ component(s)
involved.
• Review carefully surgical history, and the intended
new procedure.
• Note any existing device present that may require
attention.
Gather all the Facts
• Evaluate the objective/plan for the root
operation - differentiate between body parts
and devices.
• Examine details to identify the plan as an
alteration, bypass, change, creation, removal,
replacement, revision, or supplement.
• Review carefully the history, physical
exam, planned procedure, op report and
the pathology report.
• Evaluate against the DRG assigned for
consistency.
Personal History of Congenital Malformation –”Corrected”
Z87.7 – Personal history of (corrected) congenital malformations:
• If the anomaly has been corrected and is no longer present the code
for a personal history should be used- Conditions classifiable to Q00Q89 that have been repaired or corrected.
• Excludes1: Congenital malformations that have been partially
corrected or repaired but which still require medical treatmentCODE to the condition
Personal History of Congenital Malformation –”Corrected”
Code
Description
Z87710
Personal history of (corrected) hypospadias
Z87718
Personal history of other specified (corrected) congenital malformations of genitourinary
system
Z87720
Personal history of (corrected) congenital malformations of eye
Z8772
Personal history of (corrected) congenital malformations of ear
Z87728
Personal history of other specified (corrected) congenital malformations of nervous system and
sense organs
Z87730
Personal history of (corrected) cleft lip and palate
Z87738
Z8774
Personal history of other specified (corrected) congenital malformations of digestive system
Personal history of (corrected) congenital malformations of heart and circulatory system
Z8775
Personal history of (corrected) congenital malformations of respiratory system
Z8776
Personal history of (corrected) congenital malformations of integument, limbs and
musculoskeletal system
Z87790
Personal history of (corrected) congenital malformations of face and neck
Z87798
Personal history of other (corrected) congenital malformations
Review the codes in
Chapter 17: Congenital malformations, deformations
and chromosomal abnormalities (Q00-Q99)
Chapter 17
• All Q Codes are found in Chapter 17 of the code book Q00- Q89
• Q codes are assigned to the body system MDC and DRGs for both medical and surgical*Circulatory is one exception that has Congenital Anomaly DRGs for heart
• MDC 01 Diseases & Disorders of the Nervous System
MDC 02 Diseases & Disorders of the Eye
MDC 03 Diseases & Disorders of the Ear, Nose, Mouth & Throat
MDC 04 Diseases & Disorders of the Respiratory System
MDC 05 Diseases & Disorders of the Circulatory System
MDC 06 Diseases & Disorders of the Digestive System
MDC 07 Diseases & Disorders of the Hepatobiliary System & Pancreas
MDC 08 Diseases & Disorders of the Musculoskeletal System & Connective Tissue
MDC 09 Diseases & Disorders of the Skin, Subcutaneous Tissue & Breast
MDC 10 Endocrine, Nutritional & Metabolic Diseases & Disorders
MDC 11 Diseases & Disorders of the Kidney & Urinary Tract
MDC 12 Diseases & Disorders of the Male Reproductive System
MDC 13 Diseases & Disorders of the Female Reproductive System
MDC 14 Pregnancy, Childbirth & the Puerperium
MDC 15 Newborns & Other Meonates with Conditions Originating in Perinatal Period
MDC 16 Diseases & Disorders of Blood, Blood Forming Organs, Immunologic Disorders
MDC 17 Myeloproliferative Diseases & Disorders, Poorly Differentiated Neoplasms
MDC 18 Infectious & Parasitic Diseases, Systemic or Unspecified sites
Birth Episode DRGs
Are For Babies With Known Congenital Malformations,
Deformities And Chromosomal Abnormalities
APR-DRGs and MS-DRGs : A Few Designations for
Newborn Specific Anomaly DRGs
APR-DRGs
• 602.1-4 Neonate, Birthwt 1000-1249G W Resp Dist Synd/Oth Major Resp Or Major Anomaly
• 607.1-4 Neonate, Bwt 1250-1499G W Resp Dist Synd/Oth Major Resp Or Maj Anomaly
• 611.1-4 Neonate, Birthwt 1500-1999G W Major Anomaly
• 621.1-4 Neonate, Bwt 2000-2499G W Major Anomaly
• 633.1-4 Neonate, Birthwt > 2499g W/ Major Anomaly
• 640.1-4 Neonate, Bwt > 2499g, Normal Newborn Or Neonate W Other Problem
MS-DRGs
• DRG 791 Prematurity with Major Problems
• DRG 792 Prematurity without Major problems
• DRG 793 Full Term Neonate with Major Problems
• DRG 794 Neonate with Other Significant Problems
• DRG 795 Normal Newborns
• Conditions may be present at all stages of growth and adulthood
• Body system DRGs are used after the initial birth DRGs for care
MS-DRGs and APR-DRGs:
Only a Few Designations for “Medical” Anomaly DRGs
APR-DRGs
• 095.1-4 Cleft Lip & Palate Repair* (surgical)
• 131.1-4 Cystic Fibrosis
• 200.1-4 Cardiac Congenital & Valvular Disorders
• 662.1-4 Sickle Cell Anemia Crisis Sickle Cell
MS-DRG
• DRG 306 Cardiac Congenital and Valvular Disorders with MCC
• DRG 307 Cardiac Congenital and Valvular Disorders without MCC
Body System Specific Medical DRGs
• Q codes are assigned to body system DRGs
• Example - Microcephaly (Q02 Microcephaly) is assigned to:
MS-DRG
DRG
091
OTHER DISORDERS OF
NERVOUS SYSTEM WITH MCC
DRG
092
OTHER DISORDERS OF
NERVOUS SYSTEM WITH CC
DRG
093
OTHER DISORDERS OF
NERVOUS SYSTEM WITHOUT
CC/MCC
APR-DRG
058
SOI 1-4
Other Disorders of Nervous
System
MS-DRGs and APR-DRGs for “Medical” Anomaly DRGs
Q330
Congenital cystic lung
Q331
Accessory lobe of lung
Q332
Sequestration of lung
Q333
Agenesis of lung
Q335
Ectopic tissue in lung
Q336
Congenital hypoplasia and dysplasia of lung
Q338
Other congenital malformations of lung
Q339
Congenital malformation of lung, unspecified
Q340
Anomaly of pleura
Q341
Congenital cyst of mediastinum
Q348
Other specified congenital malformations of respiratory system
Q349
Congenital malformation of respiratory system, unspecified
Q676
Pectus excavatum
Q677
Pectus carinatum
Q766
Other congenital malformations of ribs
Q767
Congenital malformation of sternum
Q768
Other congenital malformations of bony thorax
Q769
Congenital malformation of bony thorax, unspecified
Q772
Short rib syndrome
Q790
Congenital diaphragmatic hernia
Q791
Other congenital malformations of diaphragm
MS-DRG
DRG
205
OTHER RESPIRATORY
SYSTEM DIAGNOSES WITH
MCC
DRG
206
OTHER RESPIRATORY
SYSTEM DIAGNOSES
WITHOUT MCC
APR-DRG
143
SOI 1-4
Other respiratory diagnosis
except signs, symptoms &
minor diagnoses
MS-DRGs and APR-DRGs for Cardiac and Circulatory
are Very Specific to Condition and/or Procedure
MS-DRG
APR-DRG
DRG
306
CARDIAC CONGENITAL AND
VALVULAR DISORDERS WITH
MCC
160
SOI 1-4
Major Cardiothoracic Repair of Heart
Anomaly
DRG
307
CARDIAC CONGENITAL AND
VALVULAR DISORDERS
WITHOUT MCC
161
SOI 1-4
Cardiac Defibrillator & Heart Assist
Anomaly
200
SOI 1-4
Cardiac Congenital & Valvular
Disorders
Cardiac Congenital and Valvular Disorders
Q200
Q201
Q202
Q203
Q204
Q205
Q206
Q208
Common arterial trunk
Double outlet right ventricle
Double outlet left ventricle
Discordant ventriculoarterial connection
Double inlet ventricle
Discordant atrioventricular connection
Isomerism of atrial appendages
MS-DRG
DRG
306
CARDIAC CONGENITAL AND
VALVULAR DISORDERS WITH MCC
DRG
307
CARDIAC CONGENITAL AND
VALVULAR DISORDERS WITHOUT
MCC
Other congenital malformations of cardiac chambers and connections
Q209
Congenital malformation of cardiac chambers and connections, unspecified
Q210
Q211
Q212
Q213
Q214
Q218
Ventricular septal defect
Atrial septal defect
Atrioventricular septal defect
Tetralogy of Fallot
Aortopulmonary septal defect
Other congenital malformations of cardiac septa
Q219
Congenital malformation of cardiac septum, unspecified
Pulmonary valve atresia
Congenital pulmonary valve stenosis
Congenital pulmonary valve insufficiency
160
SOI 1-4
Major Cardiothoracic Repair of Heart
Anomaly
Other congenital malformations of pulmonary valve
Congenital tricuspid stenosis
Ebstein's anomaly
Hypoplastic right heart syndrome
Other congenital malformations of tricuspid valve
161
SOI 1-4
Cardiac Defibrillator & Heart Assist
Anomaly
200
SOI 1-4
Cardiac Congenital & Valvular
Disorders
Q220
Q221
Q222
Q223
Q224
Q225
Q226
Q228
Q229
Q230
Q231
Q232
Q233
Q234
Congenital malformation of tricuspid valve, unspecified
Congenital stenosis of aortic valve
Congenital insufficiency of aortic valve
Congenital mitral stenosis
Congenital mitral insufficiency
Hypoplastic left heart syndrome
APR-DRG
Cardiac Congenital and Valvular Disorders
Q238
Q239
Other congenital malformations of aortic and mitral valves
Q240
Q241
Q242
Q243
Q244
Q245
Q248
Q249
Q250
Q251
Q252
Q253
Q254
Q255
Q256
Q2571
Q2572
Q2579
Q258
Q259
Q260
Q261
Q262
Q263
Q264
Q268
Q269
Q8740
Q87410
Dextrocardia
Levocardia
Cor triatriatum
Pulmonary infundibular stenosis
Congenital subaortic stenosis
Malformation of coronary vessels
Other specified congenital malformations of heart
Congenital malformation of heart, unspecified
Patent ductus arteriosus
Coarctation of aorta
Atresia of aorta
Supravalvular aortic stenosis
Other congenital malformations of aorta
Atresia of pulmonary artery
Stenosis of pulmonary artery
Coarctation of pulmonary artery
Congenital pulmonary arteriovenous malformation
Other congenital malformations of pulmonary artery
Other congenital malformations of other great arteries
Congenital malformation of great arteries, unspecified
Congenital stenosis of vena cava
Persistent left superior vena cava
Total anomalous pulmonary venous connection
Partial anomalous pulmonary venous connection
Anomalous pulmonary venous connection, unspecified
Other congenital malformations of great veins
Congenital malformation of great vein, unspecified
Marfan's syndrome, unspecified
Q87418
Congenital malformation of aortic and mitral valves, unspecified
Marfan's syndrome with aortic dilation
Marfan's syndrome with other cardiovascular manifestations
MS-DRG
DRG
306
CARDIAC CONGENITAL AND
VALVULAR DISORDERS WITH MCC
DRG
307
CARDIAC CONGENITAL AND
VALVULAR DISORDERS WITHOUT
MCC
APR-DRG
160
SOI 1-4
Major Cardiothoracic Repair of Heart
Anomaly
161
SOI 1-4
Cardiac Defibrillator & Heart Assist
Anomaly
200
SOI 1-4
Cardiac Congenital & Valvular
Disorders
Official Coding Guideline
• C.1.17 Assign codes from category Q00 – Q99, congenital
malformations, deformations, and chromosomal abnormalities when
a malformation/deformation or chromosomal abnormality is
documented.
 Q codes may be the principal/first – listed diagnoses on a record
or a secondary diagnoses.
 When a malfor/deform or chromosomal abnormality does not
have a unique code assignment, assign additional code(s) for
any manifestations that may be present.
 When the code assignment specifically identifies the
malfor/deform/or chromosomal abnormality, manifestations that
are an inherent component of the anomaly should not be coded
separately. Additional code should be assigned for
manifestations that are not in inherent component.
Official Coding Guideline



Codes from Chapter 17 may be used throughout the life of the
patient. If a congenital malformation or deformity has been
corrected, a personal history code should be used to identify the
history of the malformation or deformity. (code the condition until it
is corrected)
Although present at birth, malformation/deformation/or
chromosomal abnormality may not be identified until later in life.
When ever the condition is diagnosed by the physician, is
appropriate to assign a code from codes Q00 – Q99.
The condition is coded until it is completely corrected
PCS Characters
24
Root operation and approach are key
indicators of the OR impact for surgical DRGs
PCS Characters Determine Minor or Major Procedure
for Both MS and APR DRGs
• Root operations (3)
• Approach (5)
Bypass, alteration,
change, creation,
removal, replacement,
revision, or supplement
Open
Percutaneous Endoscopic
Percutaneous
Body Part & Device Characters Determine Some MSDRGs and APR-DRGs
Body part (4)
 Major organs and other major
anatomical structures
− Lungs- Bronchus
− Heart- Valves
− Brain- Ventricles
 Other tissue
− Pericardium
DRG Examples –
 Major Chest Procedure
 Other Respiratory System Procedures
 Cardiac Valve and Other Major
Cardiothoracic Procedures
 Other Cardiothoracic Procedures
Device (6)
Autologous
Non-autologous
Synthetic
Zooplastic
Defibrillator-cardiac assist
DRG Examples –
 Cardiac Defibrillator & Heart
Assist Anomaly
 Ventricular Shunt
Procedures
27
Utilize All Sources and
Documents
PCS Coding Support Documents
− Pre –procedure history of the condition and
previous procedures(episode of care)
− Informed consent and documented
indication for the procedure
− Anesthesia pre and post evaluation
− Operative/procedure report
− Brief operative/procedure progress note
− Pre and post Imaging, fluoroscopy and
other radiology/procedure reports
− Device and equipment inventory list for the
surgical case
− Pathology report –cytology report
Newborn Surgical DRGs
• Congenital conditions identified and coded at birth will generate a newborn DRG
• MS-DRGs are determined first by prematurity/full term status and then by the severity
and number of anomalies coded – MS-DRGs do not provide a surgical DRG for any
procedure performed
• APR-DRGs are assigned first by birthweight, major, minor or multiple anomalies and
major cardiovascular or other major procedures
MS-DRG
DRG
791
PREMATURITY WITH MAJOR
PROBLEMS
DRG
792
PREMATURITY WITHOUT MAJOR
PROBLEM
DRG
793
FULL TERM NEONATE WITH MAJOR
PROBLEMS
MS-DRGs do not provide any
surgical options
APR-DRG
588
SOI 1-4
Neonate BWT <1500G W Major
Procedure
609
SOI 1-4
Neonate, BWT 1500-2499G W
Major Procedure
630
SOI 1-4
Neonate, Birthwt > 2499g w/
Major Cardiovasc Procedure
Surgical DRGs
• Depending on the procedure performed the surgical DRG for minor,
major, or other procedure will be assigned.
• Example DRG: Colostomy creation (bypass)- 0D1B0Z4 for bowel
obstruction (ileum) due to congenital prune belly syndrome Q794,
with imperforate anus Q422 is assigned to DRGs:
MS-DRG
APR-DRG
DRG
329
DRG
330
DRG
331
MAJOR SMALL AND LARGE BOWEL
PROCEDURES WITH MCC
MAJOR SMALL AND LARGE BOWEL
PROCEDURES WITH CC
MAJOR SMALL AND LARGE BOWEL
PROCEDURES WITHOUT CC/MCC
221
SOI 1-4
MAJOR SMALL AND LARGE
BOWEL PROCEDURES
Surgical DRGs
• Depending on the procedure performed the surgical DRG for minor,
major, or other procedure will be assigned.
• Example DRG- Open destruction of ileum mass/nodule- 0D5B0ZZ,
for bowel obstruction due to congenital prune belly syndrome Q794,
with imperforate anus Q422 is assigned to DRGs:
MS-DRG
APR-DRG
DRG
344
DRG
345
DRG
346
MINOR SMALL AND LARGE BOWEL
PROCEDURES WITH MCC
MINOR SMALL AND LARGE BOWEL
PROCEDURES WITH CC
MINOR SMALL AND LARGE BOWEL
PROCEDURES Without CC/MCC
223
SOI 1-4
OTHER SMALL AND LARGE
BOWEL PROCEDURES
Surgical DRGs
• Depending on the procedure performed the surgical DRG for minor,
major, or other will be assigned.
• Example DRG- Open repair right thumb 0PQR0ZZ- as part of
reconstruction staged for Ectrodactyl Q7161 (lobster claw anomaly)
of right hand assigned to DRGs:
MS-DRG
APR-DRG
DRG
515
OTHER MUSCULOSKELETAL &
CONNECTIVE TISSUE O.R.
PROCEDURES WITH MCC
DRG
516
OTHER MUSCULOSKELETAL &
CONNECTIVE TISSUE O.R.
PROCEDURES WITH CC
DRG
517
OTHER MUSCULOSKELETAL &
CONNECTIVE TISSUE O.R.
320
SOI 1-4
Other Musculoskeletal &
Connective Tissue
Procedures
Some APR-DRGs are Anomaly/Anatomy Specific Repairs
• 095.1-4 Cleft Lip & Palate Repair
• 160.1-4 Major Cardiothoracic Repair of Heart Anomaly
Many surgeries and corrections will be performed shortly after birth in
the same encounter for birth.
Other surgeries may be spaced out over a span of months or years,
and involve different objectives to achieve correction or cosmetic
improvement.
Surgical DRGs
• Depending on the procedure performed the surgical DRG may
include anatomy specific repairs/corrections.
• Example DRG- Placement of ventriculo-peritoneal shunt –
0016076, for congenital hydrocephaly (Q039 Congenital
hydrocephalus, unspecified).
MS-DRG
APR-DRG
DRG
031
VENTRICULAR SHUNT
PROCEDURES WITH MCC
DRG
032
VENTRICULAR SHUNT
PROCEDURES WITH CC
DRG
033
VENTRICULAR SHUNT
PROCEDURES WITHOUT CC/MCC
022
SOI 1-4
VENTRICULAR SHUNT
PROCEDURES
Surgical DRGs
• Depending on the procedure performed the surgical DRG may
include anatomy specific repairs/corrections.
• Example DRG - Supplement of hard palate with autologous tissue
open approach - 0CU207Z for congenital cleft hard and soft palate
with bilateral cleft lip – Q374
MS-DRG
DRG
133
OTHER EAR, NOSE MOUTH, AND
THROAT PROCEDURES WITH
CC/MCC
DRG
134
OTHER EAR, NOSE MOUTH, AND
THROAT PROCEDURES WITHOUT
CC/MCC
APR-DRG
095
SOI 1-4
Cleft Lip & Palate Repair
| 35
Surgical DRGs - Episode of Care Impact
• Example APR-DRG – 1 day
old newborn- Z3800 with
Congenital Hypertrophic
Pyloric Stenosis Q400Division of pyloric stenosis 0D870ZZ
• APR-DRG
639
SOI 1-4
Neonate birthwt >2499g w
other significant condition
• Example APR-DRG – 8 day
old newborn readmitted with
Congenital Hypertrophic
Pyloric Stenosis Q400Division of pyloric stenosis 0D870ZZ
APR-DRG
222
SOI 1-4
Other Stomach, Esophageal,
Duodenal procedure
Other Congenital Diagnoses are Located in the Body System
Specific APR-DRGs
Other conditions/manifestations have anomaly specific medical DRGs
• 662.1-4 Sickle Cell Anemia Crisis Sickle cell
• 131.1-4 Cystic Fibrosis
• 200.1-4 Cardiac Congenital & Valvular Disorders
DRG Categories to Remember
Birth Episode DRGs
MS-DRGs – no
surgical options
APR-DRGs Include
weight, anomaly(s)
and surgery
Post Birth -Medical
DRGs
Primarily body
system specific
Few congenital
specific DRGs
Surgical DRGs
Anatomy/repair
specific for major or
minor, or other
procedures
Few are congenital
specific DRGs
Coding Rule
Code the condition
until corrected
May be principal or
secondary
Once corrected code
to personal history
Key Take Away Points
1. Identify the episode of care
2. Determine if the diagnosis/condition is currently
requiring care, or is only a personal history of a
past diagnosis with the condition “corrected”
3. Do not code procedures without the operative
report, procedure report or the pathology report
4. Be ready to interpret your anatomy, surgical and
device terminology
5. Differentiate the root operations used: bypass,
alteration, change, creation, removal,
replacement, revision, or supplements
Key Take Away Points
6. Determine if a device will be used and what type
7. Seek to code to the exact location of the targeted
anatomical structure and the surrounding
tissue(s) that is specified
8. Utilize all the documentation available for code
selection and decision making such as imaging
and radiology reports
9. Read the final DRG description carefully and
evaluate it against the objective and diagnosis the
patient is treated for to be sure it is consistent
with codes used for the procedures
10. Query if the information is not clear or is not
consistent
References
40
http://www.cms.gov/icd10manual/version33.0-fullcode-cms/P00124.html
http://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-PCSguidelines.pdf
https://www.health.ny.gov/facilities/hospital/reimbursement/apr-drg/weights/
ICD-10-PCS Official Guidelines for Coding and Reporting
2016 OptumCoding
[email protected]
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